Abstract
Cyclosporiasis is caused by the coccidian parasite Cyclospora cayetanensis and is associated with large and complex food-borne outbreaks worldwide. Associated symptoms include severe watery diarrhea, particularly in infants, and immune dysfunction. With the globalization of human food supply, the occurrence of cyclosporiasis has been increasing in both food growing and importing countries. As well as being a burden on the health of individual humans, cyclosporiasis is a global public health concern. Currently, no vaccine is available but early detection and treatment could result in a favorable clinical outcome. Clinical diagnosis is based on cardinal clinical symptoms and conventional laboratory methods, which usually involve microscopic examination of wet smears, staining tests, fluorescence microscopy, serological testing, or DNA testing for oocysts in the stool. Detection in the vehicle of infection, which can be fresh produce, water, or soil is helpful for case-linkage and source-tracking during cyclosporiasis outbreaks. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX) can evidently cure C. cayetanensis infection. However, TMP-SMX is not suitable for patients having sulfonamide intolerance. In such case ciprofloxacin, although less effective than TMP-SMX, is a good option. Another drug of choice is nitazoxanide that can be used in the cases of sulfonamide intolerance and ciprofloxacin resistance. More epidemiological research investigating cyclosporiasis in humans should be conducted worldwide, to achieve a better understanding of its characteristics in this regard. It is also necessary to establish in vitro and/or in vivo protocols for cultivating C. cayetanensis, to facilitate the development of rapid, convenient, precise, and economical detection methods for diagnosis, as well as more effective tracing methods. This review focuses on the advances in clinical features, diagnosis, and therapeutic intervention of cyclosporiasis.
Highlights
Cyclosporiasis is caused by Cyclospora cayetanensis, and in humans it typically induces periodic profuse watery diarrhea (Shields and Olson, 2003a; Ortega and Sanchez, 2010; Almeria et al, 2019; Giangaspero and Gasser, 2019)
This review presents an update on aspects of the clinical features, detection methods, therapy, and prevention of cyclosporiasis
Specific primers and probe Using the inherent genetic uniqueness of the 18S ribosomal gene sequence Simultaneous detection of Cyclospora cayetanensis, Cystoisospora belli, Enterocytozoon bieneusi, and Encephalitozoon intestinalis; detection of the amplicon is through specific probes coupled to Luminex beads Commercially available DNA-based technologies for stool specimens Polymorphic junction region in the mitochondrial genome for human stool samples Simultaneous detection of Cryptosporidium parvum, Giardia lamblia, and Cyclospora cayetanensis in human stool samples FDA validated technique used in fresh produce matrices and prepared dishes
Summary
Cyclosporiasis is caused by Cyclospora cayetanensis, and in humans it typically induces periodic profuse watery diarrhea (Shields and Olson, 2003a; Ortega and Sanchez, 2010; Almeria et al, 2019; Giangaspero and Gasser, 2019). Wet Smears Wet smears and conventional microscopy methods have been widely used to detect C. cayetanensis oocysts in clinical stool samples (Ortega and Sanchez, 2010). Several molecular techniques have been developed for the detection of C. cayetanensis in fresh produce, including qPCR and various multiplex qPCR methods (Steele et al, 2003; Lalonde and Gajadhar, 2011, 2016; Murphy et al, 2017; Shapiro et al, 2019) (Table 1).
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